Description of an ultrasound-guided erector spinae plane block and the spread of dye in dog cadavers

Published:March 27, 2019DOI:



      To describe a technique to perform an ultrasound-guided erector spinae plane (ESP) block and determine the distribution and potential complications after injection of two volumes of methylene blue in dog cadavers.

      Study design

      Prospective experimental cadaveric study.


      A total of eight dog cadavers weighing 9.3 ± 1.9 kg.


      Ultrasound-guided injections dorsal to the transverse process and ventral to the erector spinae muscles aimed at the fifth thoracic transverse process were performed bilaterally in each dog using 0.5 and 1.0 mL kg−1 dye solution [low volume (LV) and high volume (HV) treatments, respectively]. Treatments were randomly assigned to the right or left side of each dog, resulting in a total of 16 injections. Anatomical dissections determined dye spread characteristics, including epaxial muscles spread, staining of spinal nerves, dorsal rami, ventral rami (intercostal nerves) and sympathetic trunk spread. Staining indicating potential complications (epidural, mediastinal and intrapleural spread) was recorded.


      There was complete staining of at least one dorsal ramus following all injections. A more extensive spread was observed along the muscles in the HV compared with LV (p = 0.036). No significant difference between multisegmental dorsal rami spread (six out of eight injections in each treatment) was noted. Out of 16 injections, one in LV treatment resulted in multisegmental spinal nerve staining and one in HV treatment resulted in ventral ramus (intercostal nerve) staining. Use of anatomic landmarks resulted in inaccurate identification of the fifth transverse process in at least six out of 16 injections (38%). No sympathetic trunk, epidural, mediastinal or intrapleural staining was observed.

      Conclusions and clinical relevance

      Ultrasound-guided ESP injections resulted in extensive staining along the epaxial muscles, as well as staining of the dorsal rami in all dogs. The incidence of dorsal rami mutisegmental spread was the same in both treatments.


      To read this article in full you will need to make a payment


      Subscribe to Veterinary Anaesthesia and Analgesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Adhikary S.D.
        • Bernard S.
        • Lopez H.
        • Chin K.J.
        Erector spinae plane block versus retrolaminar block: a magnetic resonance imaging and anatomical study.
        Reg Anesth Pain Med. 2018; 43: 756-762
        • Balaban O.
        • Aydin T.
        Ultrasound guided bi-level erector spinae plane block for pain management in Herpes Zoster.
        J Clin Anesth. 2018; 52: 31-32
        • Broadbent C.R.
        • Maxwell W.B.
        • Ferrie R.
        • et al.
        Ability of anaesthetists to identify a marked lumbar interspace.
        Anaesthesia. 2000; 55: 1122-1126
        • Bugada D.
        • Zarcone A.G.
        • Manini M.
        • Lorini L.F.
        Continuous erector spinae block at lumbar level (L4) for prolonged postoperative analgesia after hip surgery.
        J Clin Anesth. 2018; 52: 24-25
        • Chin K.J.
        • Lewis S.
        Opioid-free analgesia for posterior spinal fusion surgery using erector spinae plane (ESP) blocks in a multimodal anesthetic regimen.
        Spine. 2019; 44: E379-E383
        • Chin K.J.
        • Malhas L.
        • Perlas A.
        The erector spinae plane block provides visceral abdominal analgesia in bariatric surgery: a report of 3 cases.
        Reg Anesth Pain Med. 2017; 42: 372-376
        • Chin K.J.
        • Adhikary S.
        • Sarwani N.
        • Forero M.
        The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair.
        Anaesthesia. 2017; 72: 452-460
        • Cornish P.B.
        Erector spinae plane block: the “happily accidental” paravertebral block.
        Reg Anesth Pain Med. 2018; 43: 644-645
        • De Cassai A.
        • Tonetti T.
        Local anesthetic spread during erector spinae plane block.
        J Clin Anesth. 2018; 48: 60-61
        • Elkoundi A.
        • Bentalha A.
        • Kettani S.E.E.
        • et al.
        Erector spinae plane block for pediatric hip surgery – a case report.
        Korean J Anesthesiol. 2019; 72: 68-71
        • Evans H.E.
        • de Lahunta A.
        The skeletal and muscular systems.
        in: Evans H.E. de Lahunta A. Guide to the Dissection of the Dog. 8th edn. Elsevier, USA2017: 6-95
        • Ferreira T.H.
        • Teixeira L.B.C.
        • Schroeder C.A.
        • et al.
        Description of an ultrasound-guided thoracic paravertebral block technique and the spread of dye in dog cadavers.
        Vet Anaesth Analg. 2018; 45: 811-819
        • Forero M.
        • Rajarathinam M.
        • Adhikary S.
        • Chin K.J.
        Erector spinae plane (ESP) block in the management of post thoracotomy pain syndrome: a case series.
        Scand J Pain. 2017; 17: 325-329
        • Forero M.
        • Adhikary S.D.
        • Lopez H.
        • et al.
        The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain.
        Reg Anesth Pain Med. 2016; 41: 621-627
        • Gürkan Y.
        • Aksu C.
        • Kuș A.
        • et al.
        Ultrasound guided erector spinae plane block reduces postoperative opioid consumption following breast surgery: a randomized controlled study.
        J Clin Anesth. 2018; 50: 65-68
        • Hamilton D.L.
        • Manickam B.
        The erector spinae plane block.
        Reg Anesth Pain Med. 2017; 42: 276
        • Hayes J.
        • Borges B.
        • Armstrong D.
        • Srinivasan I.
        Accuracy of manual palpation vs ultrasound for identifying the L3–L4 intervertebral space level in children.
        Paediatr Anaesth. 2014; 24: 510-515
        • Hermanson J.W.
        The muscular system.
        in: Evans H.E. de Lahunta A. Miller's Anatomy of the Dog. 4th edn. Elsevier, USA2013: 185-280
        • Hernandez M.A.
        • Palazzi L.
        • Lapalma J.
        • Cravero J.
        Erector spinae plane block for inguinal hernia repair in preterm infants.
        Paediatr Anaesth. 2018; 28: 298-299
        • Ishizuka K.
        • Sakai H.
        • Tsuzuki N.
        • Nagashima M.
        Topographic anatomy of the posterior ramus of thoracic spinal nerve and surrounding structures.
        Spine (Phila Pa 1976). 2012; 37: E817-E822
        • Ivanusic J.
        • Konishi Y.
        • Barrington M.J.
        A cadaveric study investigating the mechanism of action of erector spinae blockade.
        Reg Anesth Pain Med. 2018; 43: 567-571
        • Jones M.R.
        • Urits I.
        • Shnider M.R.
        • Matyal R.
        Confirmation of erector spinae plane block analgesia for 3 distinct scenarios: a case report.
        A A Pract. 2019; 12: 141-144
        • Josh Luftig P.A.
        • Mantuani D.
        • Herring A.A.
        • et al.
        The authors reply to the optimal dose and volume of local anesthetic for erector spinae plane blockade for posterior rib fractures.
        Am J Emerg Med. 2018; 36: 1103-1104
        • Luis-Navarro J.C.
        • Seda-Guzmán M.
        • Luis-Moreno C.
        • Chin K.J.
        Erector spinae plane block in abdominal surgery: case series.
        Indian J Anaesth. 2018; 62: 549-554
        • Marhofer D.
        • Marhofer P.
        • Kettner S.C.
        • et al.
        Magnetic resonance imaging analysis of the spread of local anesthetic solution after ultrasound-guided lateral thoracic paravertebral blockade: a volunteer study.
        Anesthesiology. 2013; 118: 1106-1112
        • Melvin J.P.
        • Schrot R.J.
        • Chu G.M.
        • Chin K.J.
        Low thoracic erector spinae plane block for perioperative analgesia in lumbosacral spine surgery: a case series.
        Can J Anaesth. 2018; 65: 1057-1065
        • Mowbray A.
        • Wong K.K.
        Low volume intercostal injection. A comparative study in patients and cadavers.
        Anaesthesia. 1988; 43: 633-634
        • Nagaraja P.S.
        • Ragavendran S.
        • Singh N.G.
        • et al.
        Comparison of continuous thoracic epidural analgesia with bilateral erector spinae plane block for perioperative pain management in cardiac surgery.
        Ann Card Anaesth. 2018; 21: 323-327
        • Nair A.S.
        • Seelam S.
        • Naik V.
        • Rayani B.K.
        Opioid-free mastectomy in combination with ultrasound-guided erector spinae block: a series of five cases.
        Indian J Anaesth. 2018; 62: 632-634
        • Nath S.
        • Bhoi D.
        • Mohan V.K.
        • Talawar P.
        USG-guided continuous erector spinae block as a primary mode of perioperative analgesia in open posterolateral thoracotomy: a report of two cases.
        Saudi J Anaesth. 2018; 12: 471-474
        • Portela D.A.
        • Otero P.E.
        • Sclocco M.
        • et al.
        Anatomical and radiological study of the thoracic paravertebral space in dogs: iohexol distribution pattern and use of the nerve stimulator.
        Vet Anaesth Analg. 2012; 39: 398-408
        • Portela D.A.
        • Campoy L.
        • Otero P.E.
        • et al.
        Ultrasound-guided thoracic paravertebral injection in dogs: a cadaveric study.
        Vet Anaesth Analg. 2017; 44: 636-645
        • Restrepo-Garces C.E.
        • Chin K.J.
        • Suarez P.
        • Diaz A.
        Bilateral continuous erector spinae plane block contributes to effective postoperative analgesia after major open abdominal surgery: a case report.
        A A Case Rep. 2017; 9: 319-321
        • Schwartzmann A.
        • Peng P.
        • Maciel M.A.
        • Forero M.
        Mechanism of the erector spinae plane block: insights from a magnetic resonance imaging study.
        Can J Anaesth. 2018; 65: 1165-1166
        • Taketa Y.
        • Irisawa Y.
        • Fujitani T.
        Ultrasound-guided erector spinae plane block elicits sensory loss around the lateral, but not the parasternal, portion of the thorax.
        J Clin Anesth. 2018; 47: 84-85
        • Tsui B.C.H.
        • Fonseca A.
        • Munshey F.
        • et al.
        The erector spinae plane (ESP) block: a pooled review of 242 cases.
        J Clin Anesth. 2018; 53: 29-34
        • Tulgar S.
        • Selvi O.
        • Ozer Z.
        Clinical experience of ultrasound-guided single and bi-level erector spinae plane block for postoperative analgesia in patients undergoing thoracotomy.
        J Clin Anesth. 2018; 50: 22-23
        • Yang H.M.
        • Choi Y.J.
        • Kwon H.J.
        • et al.
        Comparison of injectate spread and nerve involvement between retrolaminar and erector spinae plane blocks in the thoracic region: a cadaveric study.
        Anaesthesia. 2018; 73: 1244-1250